"However," cautions Dr. Zhang, "when consuming a high amount of caffeine or four cups or more daily of coffee, there is a possibility of increased risk of breast cancer for women with benign breast disease."

In addition, there could be an increased risk for developing certain subtypes of breast tumors that have less favorable prognoses, says Dr. Zhang.

Caffeine Linked to Benign Breast Problems

The authors note that caffeine - found in coffee, chocolate, tea, soft drinks, and various medications - is thought to be the world's most commonly ingested drug.

That said, recent research focused on women diagnosed with non-cancerous breast disease revealed that cutting caffeine from the diet could improve symptoms among such patients.

Because benign breast disease is considered to be a risk factor for developing the malignant form of the disease, this finding had raised concerns that caffeine might also elevate the risk for breast cancer.

To explore this possibility, Dr. Zhang looked at the diets of almost 39,000 women over the age of 45 over a period of four years, between 1992 and 1995.

All the women were part of The Women's Health Study, a cohort of US health professionals, and 75 percent were registered nurses.

All the women worked as health-care professionals - three-quarters as registered nurses.

The research team observed that nearly one-quarter never drank coffee, and about another quarter drank either one cup or less per day. Almost a third consumed two to three cups per day, while just over 15 percent downed four or more cups on a daily basis.

Within a decade following the collection of dietary information nearly 1,190 of the women developed invasive breast cancer.

Yet, consuming caffeine in any of its forms was not found to be significantly associated with breast cancer risk.

However, among those with a history of benign breast cancer disease, those consuming caffeine at the highest end of the scale did have a "borderline significantly increased risk" for malignant disease.

A similar positive link was found between caffeine consumption and the risk for developing tumors larger than two centimeters.

Caffeine raised the risk for such tumors by 79 percent, says Dr. Zhang.

The risk for developing certain forms of breast cancer - known as estrogen and/or progesterone receptor-negative breast cancer - also rose with caffeine consumption by 68 percent, the researcher notes.

Complex Findings, Moderate Use Best

Since breast cancers and tumors in excess of two centimeters are associated with poorer outcomes, it is important to continue investigating whether or not caffeine truly has a negative impact on the development of specific kinds of breast cancer - even if the general risk remains insignificant.

Dr. Alan Astrow, at Maimonides Medical Center in New York City, suggests the findings are both comforting and preliminary.

"Overall, the results of this study should be reassuring to women who are concerned about their risk of breast cancer and who also like to drink coffee moderately," he says.

"However, the field of diet and breast cancer risk remains one of active research, and the results of these kinds of investigations are not always easy to interpret. It is possible that future studies will show a different result,” explains Dr. Astrow.

Dr. Larry Norton at Memorial Sloan-Kettering Cancer Center in New York City, agrees.

The findings "might motivate further studies [which the authors propose], but are not definitive in themselves," he says. "Hence, there is nothing in this paper to suggest that at this time someone should not consume caffeine for fear of increasing her risk of developing breast cancer."

Always consult your physician for more information.

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January 2009

Breast Cancer Awareness

Routine care is the best way to keep you and your breasts healthy. Although detecting breast cancer at its earliest stages is the main goal of routine breast care, other benign conditions, such as fibrocystic breasts or cysts, are often discovered during routine care.

According to the National Cancer Institute (NCI), when breast cancer is found early and is still localized (restricted to the site of origin, without evidence of spread), the relative survival rate, when measured at five years, is 98 percent.

When breast cancer is found at a late stage (cancer that has spread to distant parts of the body), the survival rate at five years is 26 percent.

Although the incidence of breast cancer is beginning to decrease, one out of eight women will develop invasive breast cancer at some point in their lives. Mortality rates have decreased over the past several years due to early detection and improved treatment.

If you are diagnosed with breast cancer, the most important thing for you to remember is that it is not a hopeless condition. Early detection and modern therapy with a combination of surgery, radiation, drugs, or hormones can help many patients.

Although there are some women who are at higher risk, the fact is that all women are at risk for breast cancer. That is why it is so important to follow this three-step plan for preventive care. Although breast cancer cannot be prevented at the present time, early detection of problems provides the greatest possibility of successful treatment.

Step 1. Breast Self-Examination (BSE)A woman should begin practicing breast self-examination by the age of 20 and continue the practice throughout her life - even during pregnancy and after menopause. BSE should be done regularly at the same time every month. Regular BSE teaches you to know how your breasts normally feel so that you can more readily detect any change.

Changes may include development of a lump, a discharge other than breast milk, swelling of the breast, skin irritation or dimpling , or nipple abnormalities (i.e., pain, redness, scaliness, turning inward).

If you notice any of these changes, see your healthcare provider as soon as possible for evaluation.

Step 2. Clinical Examination
A breast examination by a physician or nurse trained to evaluate breast problems should be part of a woman's physical examination. The American Cancer Society recommends:

Between the ages of 20 and 39, women should have a clinical breast examination by a health professional every three years.

After age 40, women should have a breast examination by a health professional every year. A physical breast examination by a physician or nurse is very similar to the procedures used for breast self-examination.

Women who routinely practice BSE will be prepared to ask questions and have their concerns addressed during this time.

Step 3. MammographyMammography is a low-dose x-ray of the breasts to find changes that may occur. It is the most common imaging technique. Mammography can detect cancer or other problems before a lump becomes large enough to be felt, as well as assist in the diagnosis of other breast problems. However, a biopsy is required to confirm the presence of cancer.

According to the NCI, women in their 40s and older should begin having a screening mammogram on a regular basis, every one to two years. But, the American Cancer Society recommends that by age 40, women should have a screening mammogram every year. (A diagnostic mammogram may be required when a questionable area is found during a screening mammogram.)

Both organizations suggest that women who may be at increased risk for breast cancer should talk with their physicians about whether to begin having mammograms at an earlier age.